Healthcare Provider Details

I. General information

NPI: 1598008401
Provider Name (Legal Business Name): PAUL D WOODYARD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MCCOY RD
HUNTINGTON WV
25701-4937
US

IV. Provider business mailing address

2001 MCCOY RD
HUNTINGTON WV
25701-4937
US

V. Phone/Fax

Practice location:
  • Phone: 304-529-6205
  • Fax:
Mailing address:
  • Phone: 304-529-6205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number8117
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: